Eur Urol Oncol: How effective is neoadjuvant 177Lu-PSMA-I&T radionuclide therapy in patients with high-risk prostate cancer?

High-risk localized prostate cancer (HRLPC) remains at high risk of
disease progression after topical treatment.
New adjuvant systemic therapy for primary tumors and micrometastatic diseases prior to local therapy may improve tumor outcomes
.

Recently, researchers from Israel published an article in Eur Urol Oncol to evaluate whether lutetium-177 prostate-specific membrane antigen radioligand (LuPSMA) can be safely used in patients with HRLPC prior to robotic-assisted radical prostatectomy (RARP) and elaborated on immediate oncology results
.

The study was an open-label, single-arm clinical trial
.
Selected patients had HRLPC and elevated
radioligand uptake on PSMA positron emission tomography/computed tomography.
Participants were given two or three doses of LuPSMA radioligand (7.
4 GBq) at intervals of 2 weeks
.
Four weeks after the last dose of LuPSMA, RARP and lymphadenectomy
are performed.
The researchers measured the incidence of surgical complications, changes in surgical parameters, functional and quality of life indicators, and immediate oncology outcomes (histological outcomes and biochemical responses) and performed a descriptive analysis
of the data.

A total of 14 patients (median age 67 years)
were included in the study.
Prostate-specific antigen decreased by 17% (interquartile range [IQR] 9-50%) after two LuPSMA doses and by 34% (IQR 11-60%)
after three doses.
Thirteen patients underwent RARP surgery with no identifiable anatomical changes or intraoperative complications
.
Four patients (30%) developed postoperative complications (pneumonia, pulmonary embolism, urinary leakage and urinary tract infection).

At 3 months postoperatively, 12 patients (92%) needed a mat or less
.
The final overall pathology showed that 7 patients (53%) had positive surgical margins and 3 patients (23%) had surgical margins reduced to the Level 3 group
of the International Society of Urological Pathology.
Treatment-related effects include clear vacuolar cytoplasm and nuclear vacuoleization
.

Intraoperative and postoperative outcomes in 13 patients

In summary, RARP after LuPSMA appears to be surgically safe
.
While oncological results remain to be seen, recovery from urinary incontinence does not appear to be affected by
LuPSMA treatment.

Original source:

Shay Golan， Michael Frumer， Yarden Zohar et al.
Neoadjuvant 177Lu-PSMA-I&T Radionuclide Treatment in Patients with High-risk Prostate Cancer Before Radical Prostatectomy： A Single-arm Phase 1 Trial.
Eur Urol Oncol.
Oct 2022